Epidemiology Examination

Name : Gede Bagus Subha Jana Giri

Student Number : 201872402

Major : Master of Public Health

SCHOOL OF PUBLIC HEALTH

JILIN UNIVERSITY CHINA

 The Relationship Between Meditation Practice and the occurrence of
Depression

1.1.Background

With emerging evidence and study about meditation that has been proven to give benefit for
health, it makes meditation become one of the interventions in the medical field. Based on US
nation 2012 Health Interview Survey in 2012, people meditate for several reason include
general wellness (76,2%), Improving energy (60%), and aiding memory or concentration
(50%) , Anxiety (29,2%) stress (21,6%) and depression (17,8%). From this study found that
63,6% reported that meditation helped to relieve mental problem such as depression and
anxiety(1). Meditation is defined as the intentional self-regulation of attention from moment to
moment. The aimed of this method is to achieve the relaxation and calm effect on our mind
and body. This kind of technique originated from Asia, then in 1960 it becomes popularized in
western culture. There are many of kind of meditation style and techniques including Chakra
yoga, Rinzai Zen, Mudra Yoga, Sufism, Yoto Zen, and Buddhism Insight meditation, but there
are two common meditation techniques that have been discussed which are transcendental
meditation and mindfulness meditation(2). Mindfulness is the state of mind that focus on
(3)
moment by moment experience with an attitude of curiosity, openness and acceptance .
Currently, this type of meditation has been popular as a complementary method for therapeutic
medication for various medical and psychiatric condition(3,4). In one of the study found that the
intervention of meditation techniques obtained significant improvement in depressive, anxious
(5,6)
symptoms and management of pain . In psychiatric, the effect of meditation has relation
with brain function and structure of the brain, which includes its effect on the Cortical midline
stricture and insula which has a correlation with self-referential thinking and emotional
dysregulation in mood disorder, and also with anxiety disorder(3). Meditation also increases the
activation of lateral prefrontal cortex, which is to create anxious patient to be calmer.
Meditation also has influence amygdala which is part of the brain that associated with anxiety
and depression. In some research prove that meditation decrease the activation of amygdala,
although in some of the cases it has been reported also there is activation of amygdala.
Meanwhile, from biological mechanism, meditation has an impact on the hypothalamic
pituitary adrenal axis and the sympathetic nervous system which are the component of human
stress system. Meditation also has impact on the cortisol awakening response and reduce level
of cortisol level which associated with stress level(3,4). Even though the mechanism the effect
of meditation hasn't fully understood, but from many research found that meditation has
increased the ability of someone to be more focus and be attentive to the present moment, so
as the result it will facilitate detachment from negative psychological condition such as
depression(5). Depression is feelings of sadness and/ or a loss of interest in activities once
enjoyed. Depression has become major problem and burden in mental health system, in China
has been reported that overall estimation of current 12 month and lifetime prevalence rates for
depression is 2% in rural area and 1,7% in urban area, with female prevalences 2,1% and 1,3%
of male prevalence(7). It has variety symptom and it decreases ability of people in conducting
their daily task. Depression symptom can vary from mild to severe and can include:

1. Feeling sad or having a depressed mood

2. Loss of interest or pleasure in activities once enjoyed
3. Change in appetite-weigh loss or gain unrelated to dieting
4. Trouble sleeping or sleeping too much
5. Loss of energy or increase fatigue
6. Increase in purposeless physical activities
7. Feeling worthless or guilty
8. Difficulty thinking, concentrating or making decision
9. Though of death or suicide

The symptoms must at least two weeks for a diagnosis of depression(8). Depression is a
multifactorial disorder and with several causes and etiological, but as the understandable
underlying of this disease is the dysfunction of the hypothalamic-pituitary-adrenal axis and
stress-related hormone ( such as glucocorticoid), disequilibrium of neurotransmitter and neuro-
(9).
progressive and neuroprotective factor Depressive disorder treatment currently using
pharmacological and psychotherapeutic treatment, with this kind of intervention the remission
less than 50% of the time with multiple trials, and overall have moderate effect sizes. But with
this kind of treatment patient with a medical illness, pharmacotherapeutics for depression carry
the risk for polypharmacy, drug interaction and increased the side effect. This cause the need
to find new treatment with low risk and benefit for the people with such kind condition. The
interest of using mind-body therapies for depressive disorder and other psychiatric disorder is
high among patient and increasing among practitioners that is include using mindfulness
meditation(10).
1.2.Research Question
Is there any significant association between meditation and depression

1.3.Research important
- This research expected to provide any evidence about the correlation between
meditation with depression, in order to establish further research to discover adjuvant
approachment toward depression

1.4.Research Purpose
- This study is to analyze the association between meditation and also depression

1.5.Methode and Data

a. Study Design
This study was conducted in a cross-sectional study. A cross-sectional study is an
epidemiological study that has a purpose to asses the prevalence of the exposure to the
outcome of the participant at the same time. In this study design, we choose one place
in Bali-Indonesia. After that we give them questionnaire to examine the level of
depression. In this study will using questionnaire using The Beck Inventory Assesment.
This is a 21 question multiple choice which can assess depressive symptom from mild
into severe.

b. Sample
To calculate adequate sample size we conducted the sample size formula for cross-
sectional study, which is
𝑍 2 𝑃(1 − 𝑃)
n=
𝑑2

n : Sample Size
Z : Statistic corresponding to level confidence
P : Prevalence (be obtained from same studies or a pilot study conducted
by the researchers
d : precision
From this formula, we got the amount of sample size as

1,962 0,636(1 − 0,636)

353 =
0,052

The estimated number of sample size in this research is 353, which using standard of level
confidence 95%, and p number was taken from the previous study in the USA among adult
which stated that meditation has an impact on mental health problem as 63,6%, with the
limitation of error is 5%.

1.6.Mechanism of Collecting Sample

We collecting the sample using simple random sampling. We gathering the information of
people who conducting meditation and not. After that, we do lottery method to get the
sample. Then we assessing their level of depression using The Beck Inventory Assesment
Inclusion criteria
- Doing meditation more than 3 months consecutively
- Respondent agreed to join the Questionaire

Exclusion Criteria

- Respondent does not join meditation in 3-month consecutively

- Respondent disagree to join the study
-
1.7.Statistical Analysis
After collecting all the data, We use Spss software to analyze the data. To determine the
association between correlation of two variable we use Prevalence ratio. After that to test
our hypothesis, we conducted using Chi-Square. This statistic method has been used for
comparing whether two variable has an association. This test just can determine whether
two variabel has relation or not, but can't distinguish any correlation between two variables
1.8.Reference
1. Cramer H, Hall H, Leach M, Frawley J, Zhang Y, Leung B, Adams J, Lauch R.
Prevalence, pattern, and predictors of meditation use among Us adults: A nationality
representative survey; Scientific Report 2016:1-9
2. Xie JF, Zhou JD, Gong LN, De santo lennaco J, Ding QS.Mindfulness-based cognitive
therapy in the intervention of psychiatric disorder: A review; International Journal of
Nursing Science 2014.232-239
3. Marchand W. Mindfulness-Based Stress Reduction, Mindfulness-Based Cognitive
Therapy, and Zen Meditation for Depression, Anxiety, Pain, Psychological Distress;
Journal of Psychiatric Practise 2012:18:233-252
4. Deberry S. The Effect Of Meditation Relaxation On Anxiety and Depression In
Geriatric Population; Psychotherapy: Theory, Research And Practise 1982:19: 513-520
5. Schreiner I, Malcolm JP.The Benefit of Mindfulness Meditation: Change in Emotional
States Of Depression, Anxiety and Stress; Behaviour Change 2012:25:156-168
6. Goyal M, Singh S, Erica M.S, Gould, Seymour R.A, Sharma E, Berger Z., etc.
Meditation Program for Psychological Stress and Well being: A Systematic Review
and Meta-analysis. JAMA Intern Med 2014:174(3):357-368
7. Hou Z, Jiang W, Yin Y, Zhang ZH, Yuan Y. The Current Situation on Major Depressive
Disorder in China: Research on Mechanism and Clinical Practise. Neurosci.Bull
2016:32(4):389-397
8. Parekh R, 2017. What is Depression [Online] Available at : http://
https://www.psychiatry.org/patients-families/depression/what-is-depression [ Accessed 6
April 2019]
9. Slavich GM, Irwin M.From Stress to inflammation and Major Depressive Disorder; A Social
Signal Transduction Theory of Depression. Psycho Bull 2014:140(3):774-815
10. Frank E, Novick D, Kupfer D. Antidepressants and psychotherapy: a clinical research review.
Dialogues Clin Neurosci.2005:7(3):263-272